Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Shock. 2024 Jan 1;61(1):76-82. doi: 10.1097/SHK.0000000000002264. Epub 2023 Nov 15.
Objective: To investigate whether pediatric sepsis phenotypes are stable in time. Methods: Retrospective cohort study examining children with suspected sepsis admitted to a Pediatric Intensive Care Unit at a large freestanding children's hospital during two distinct periods: 2010-2014 (early cohort) and 2018-2020 (late cohort). K-means consensus clustering was used to derive types separately in the cohorts. Variables included ensured representation of all organ systems. Results: One thousand ninety-one subjects were in the early cohort and 737 subjects in the late cohort. Clustering analysis yielded four phenotypes in the early cohort and five in the late cohort. Four types were in both: type A (34% of early cohort, 25% of late cohort), mild sepsis, with minimal organ dysfunction and low mortality; type B (25%, 22%), primary respiratory failure; type C (25%, 18%), liver dysfunction, coagulopathy, and higher measures of systemic inflammation; type D (16%, 17%), severe multiorgan dysfunction, with high degrees of cardiorespiratory support, renal dysfunction, and highest mortality. Type E was only detected in the late cohort (19%) and was notable for respiratory failure less severe than B or D, mild hypothermia, and high proportion of diagnoses and technological dependence associated with medical complexity. Despite low mortality, this type had the longest PICU length of stay. Conclusions: This single center study identified four pediatric sepsis phenotypes in an earlier epoch but five in a later epoch, with the new type having a large proportion of characteristics associated with medical complexity, particularly technology dependence. Personalized sepsis therapies need to account for this expanding patient population.
探究儿科脓毒症表型是否具有时间稳定性。
回顾性队列研究，纳入了在一家大型儿童医院儿科重症监护病房（PICU）接受治疗的疑似脓毒症患儿，这些患儿来自两个不同时期：2010-2014 年（早期队列）和 2018-2020 年（晚期队列）。使用 K-均值共识聚类法分别对两个队列中的表型进行分析。纳入的变量确保了对所有器官系统的代表性。
早期队列有 1091 例患儿，晚期队列有 737 例患儿。聚类分析在早期队列中得到了 4 种表型，在晚期队列中得到了 5 种表型。有 4 种表型在两个队列中都存在：A 型（早期队列的 34%，晚期队列的 25%），为轻度脓毒症，仅有轻微的器官功能障碍和低死亡率；B 型（25%，22%），为原发性呼吸衰竭；C 型（25%，18%），为肝功能障碍、凝血功能障碍和更高的全身性炎症标志物；D 型（16%，17%），为严重多器官功能障碍，需要高度的心肺支持、肾功能障碍和最高的死亡率。E 型仅在晚期队列中发现（19%），其特点是呼吸衰竭不如 B 型或 D 型严重，体温轻度降低，且与医疗复杂性相关的诊断和技术依赖比例较高。尽管死亡率较低，但这种类型的 PICU 住院时间最长。
这项单中心研究在较早的时期确定了 4 种儿科脓毒症表型，但在较晚的时期确定了 5 种表型，新的表型具有很大比例与医疗复杂性相关的特征，特别是对技术的依赖。个性化的脓毒症治疗需要考虑到这一不断扩大的患者群体。
